下呼吸道感染革兰氏阴性杆菌的分布、药敏及耐药分析

Distribution and analysis of drug sensitivity tests and drug-resistance of lower respiratory tract infection by gram-negative bacteria

目的 :了解院内下呼吸道感染革兰氏阴性杆菌的分布 ,以供临床用药借鉴。方法 :院内下呼吸道感染患者的痰和下呼吸道分泌物进行培养 ,共获得 139株革兰氏阴性杆菌。抗生素敏感性测定采用Kribry Bauer(KB)纸片法 ,最低抑菌浓度 (MIC)采用琼纸二倍稀释法 ,超广谱 β 内酰胺酶 (ESBLs)的测定采用Etest法。结果 :①铜绿假单胞菌(PA)和肺炎克雷伯杆菌 (KLB)在 139株细菌中分别占 33.8%和 16 .5 %。②药物敏感试验显示 :伊米配能、头孢哌酮、头孢曲松、头孢他定、环丙沙星、阿米卡星对革兰氏阴性杆菌的敏感率分别为 94 % ,87% ,85 % ,90 % ,78%和 88% ,氨苄西林、头孢唑林、氧哌嗪的耐药率分别为 90 % ,88%和 4 0 %。③有 4例ESBLs检测结果为阳性。结论 :①铜绿假单胞菌和肺炎克雷伯杆菌构成院内下呼吸道感染的主要致病菌 ;伊米配能、头孢哌酮、头孢曲松、头孢他定、环丙沙星、阿米卡星等抗生素是治疗下呼吸道感染的有效抗生素。②应加强监测ESBLs菌株。

Objective To investigate the distribution, drug sensitivity tests and drug resistance of gram negative bacteria in the respiratory ward. Methods Sputum culture was made in the patients with lower respiratory tract infection and 139 strains of gram negative bacteria were obtained. Drug sensitivity was examined by the Kribry Bauer (KB) paper method, minimal inhibitory concentration (MIC) by the agar double dilute method, and Extended Spectrum β lavtamases (ESBLs) by the E test. Results ① Among the 139 strains of gram negative bacteria, pseudomonas aeruginoea and klebsiella bacillus accounted for 33.8%, and 16.5%, respectively. ② The drug sensitivity rates of impienem, cefoperazone, ceftrixone, ceftazidine, ciprofloxacin, and amikacin were 94%, 87%, 85%, 90%, 78%,and 88%, respectively. The drug resistance rates of amipician, cefazolin, and piperacilion were 90%, 88%, and 40%, respectively. ③ There were 4 positive cases detected by ESBLs. Conclusion ① Pseudomonas aeruginoea and klebsiella bacillus were the main pathogens in lower respiratory tract infection in the hospital. Impienem, cefoperazone, ceftrixone, ceftazidine, ciprofloxacin,and amikacin are effective antibiotics for treating lower respiratory tract infection. ② The monitoring of ESBLs should be enhanced.